When The IME Doctor Agrees With Your Doctor

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Under the Illinois Workers’ Compensation Act, insurance companies have the right to send injured workers to a physician of their choosing for an evaluation. This process is from Section 12 of the Act and is commonly referred to as an Independent Medical Examination (IME).

Despite the name, IMEs are rarely “independent.” In many cases, these exams last only a few minutes, and the resulting report reflects the insurer’s interests rather than the worker’s medical reality. The IME is used to dispute the opinions of your treating physician and to justify a denial of benefits. It can be very frustrating as a lot of these doctors are hired guns who will say whatever the insurance company wants.

When the IME Supports Your Case

Not every IME results in a negative report for the worker. In fact, on occasion, the examining physician cannot reasonably deny the connection between the injury and the job. In these situations, the IME will actually confirm the treating doctor’s findings. For example, the IME may agree that your condition is work-related, that you require time off to recover, and/or that surgery is necessary.

This type of outcome is very favorable for an injured worker. However, it does not always mean that the insurance company will cooperate.

Insurance Company Tactics After a Favorable IME

Instead of moving forward with treatment approval, insurers sometimes engage in tactics designed to delay or avoid responsibility:

• Withholding the IME Report
  A common tactic is simply failing to provide the report to you. If more than two weeks pass and the insurer claims the report is not ready, that explanation is often not true. After a month, it is almost certainly a deliberate delay. The goal is to push you toward using your own health insurance or force you back to work without pay.
• Suppressing the Report
  In some cases, the IME doctor may verbally indicate support for your claim, but the insurer instructs them not to prepare a written report. Legally, if no report is issued, it is assumed that the findings would have been favorable to the injured worker.
• Requesting a Second IME
  Occasionally, insurers attempt to schedule a second IME, hoping for a different outcome. Unless there is a new medical issue to evaluate, you are not required to go to it. Courts generally view multiple IMEs within a short period as improper, especially if the insurer has withheld the first report.

If the IME supports your case but the insurance company refuses to act, then it is time to take legal action. Your workers compensation attorney can subpoena the IME doctor to obtain the report. They can also file a Section 19(b) petition for an immediate hearing, forcing the insurer to move forward. These steps hold the insurance company accountable and ensure that your rights are protected.